Jessica Rechani 123122M IA M I BEACH
B O A R D A N D C O M M IT T E E C H E C K L IS T
aeon»re. )$Sia_ßeuani
B O AR D I c oM M r T T . )Sabi{) e$S (er#ie
FOR SCANNER
Scan o
Scan o
Scan o
Scan o
Scan o
DATE OF AP Po wTM N r.11 /£?/2 0 0
Avoca sDQ'A36$r;A Cha les
rev e a. 12/31/qd@%,« u+.12 /31/a2 FOR CLERK STAFF
o Letter of Appointment
o Letter of Reappointment
o iGop'} ,oJ... L,ètteO ~pointmenUReappointment e-mailed to Committee
·o ró Gr@cómitee Aotcaton comolees a_[///Q2o
• Resume@ureuuve t2/' 7/
o Diversity Statistics Reporting (Completed on /_ L_ ,)2oO
o Oath
Liaison on
RECEIVED
DEC 1 8 2020
CI TY O F MI AM I BE A CH
OFFICE Or T I E r T C LE R K
IMPORTANT INFORMATION FOR BOARD AND COMMITTEE MEMBERS BOOK
✓City Code Ordinance Section applicable to the agency, board or committee
✓City Code Sections 2-21, 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 and 2-459
✓County Code Section 2-11.1 - Conflict of Interest and Code of Ethics Ordinance (as
amended through December 201 O)
✓Amendments to the Code of Ethics Ordinance (September 2009 through July 2012)
✓Highlights of the Miami-Dade County Ethics Code
✓Sunshine Law and Public Records -- Frequently Asked Questions
✓Memorandum - Solicitation by City Board and Committee Members
Scan o
Scan o
o Citywide Permit Application (Parking Department Form)
o Booklet - Guide to Sunshine Amendment & Code of Ethics for Public Officers and Employees
o Source of Income Statement
o Acknowledgment of Financial Disclosure Requirement . ¡º DIVER~ITY STATI.STICS REPORTl.2)- ~ee~ COPY in file and ORIGINAL for Ann ual Report.
c es. L91y7/2020 s »X ,Achat,kerut/je
.Date B
..../hl/oro». £$.= ale]
Scanned one ¡:;} /J 71 .2-o..JC\iy Employee, / =' ._,, ,.,, .JC-=
ate
CONCLUDED & RESIGNATION LETTERS
Term Expired Letter Date Processed Initials Scan o
Resignation Letter Date Processed Initials Scan o
Removal Letter due to absences Date processed Initials Scan o
F:\C LER\BO AR D AND CO M M ITT IES DATABASE\CHEC KLI ST M ASTER\B&C Checklist 2015 M ASTER.docx
We are committed to poroviding excellent public service cnd safety to all who live, work, and play in our vibrant, tropical, historic com munity
M IA M I BEACH
City of Miami Beach, 1700 Convention Cen ter Drive, Miami Beach, Florida 33 139 wyNw_miamiba chf]go
OFFICE OF THE CITY CLERK, Rafael E. Granado, City Clerk
Tel: 305.673.7411, Fac 305.673.7254
Email: CiyClerk@miamibeachlfl.gov
N ovem ber 08, 2020
M s. Jessica Fern anda R echani
3200 C ollins A ve 111
M iam i Beach, Florida 33140
SUBJECT: Disability Access Committee
C ongratulations! Y ou have been reappointed by Commissioner Ricky Arriola to the above referenced,
board or com m ittee nam ed above, fo r a term ending: 12/31/2022.
P ursuant to C ity of M iam i B each C ode S ection 2-22 (5) a, "Notw ithstanding any other provision of the
C ity C ode or of any resolution, com m encing w ith term s beginning on or after Jan uary 1, 2007, the term of
every board m em ber w ho is directly appointed by a m em ber of the C ity C om m ission shall autom atically
expire upon the latter of: D ecem ber 31 of the year the appointing C ity C om m issioner leaves office or
upon th e appoi ntm ent/election of the successor C ity C om m ission m em ber."
If you are unable to accept this appointm ent, or have any questions, please call the O ff ice of the C ity
C lerk at 305.673.7411. P lease read the enclosed m aterials carefully.
C ongratulations and good luck.
R egards,
R afa el G ranado
C ity C lerk
cc: S aul Frances, P arking D irector
V aleria M ejia, C ity Li aison
ATT ACHMENTS:
Letter of A ppointm ent
O ath
C ity C ode/O rdinance section applicable to agency, board or com m ittee
C ity C ode S ection 2-22, 2-23, 2-24, 2-25, 2-26, 2-458 an d 2-459
O rdinance No. 2006-3543 - Am endm ent to C ity C ode S ection 2-22
M iam i-Dade C ounty C ode S ection 2-11.1 - C onfli ct of Interest and C ode of Ethics O rdinance
C ity Wi de P erm it Ap pl ication - (P arkin g D epartm ent Form )
Booklet - G uid e to the S unshine A m endm ent and C ode of Ethics for P ublic O ffi cers and E m ployees
M IAMI BEACH
City of Miami Beach, 1700 Convention Center Drive, Miami Bach, Florida 33 139 yyaw_miamibachf]go
OFFICE OF THE CITY CLERK, Rafael E. Granado, Ciy Clerk
Tel: 305.673.7411, Fax 305.673.72 54
Email: CityClerk@miamibeachfl.gov
Oath of Office
Oath of Civility
and
Acknowledgements
TO: Ms. Jessica Fernanda Rechani
RE: Disability Access Committee
I do solemnly swear or affirm to bear true faith, loyalty and allegiance to the Government of the United
States, the State of Florida, and the City of Miami Beach, and to perform all the duties of a member of the
above-mentioned board or committee of the City of Miami Beach to which I have been appointed for a
term ending: 12/31/2022.
To my colleagues and to all of those I represent and serve, I pledge fairness, integrity and civility, in all
actions taken and all communications made by me as a public servant.
I have been issued a copy of section 2-11.1 of the Miami-Dade County Code (Conflict of Interest and
Code of Ethics Ordinance), as well as Florida Commission on Ethics Guide to the S nshine Amendment
and Code of Ethics for Public Officers and understand that as a member of aCi of iami Beach Board
and/or Committee, I must comply with the financial disclosure requirem ents ia ·-Dade County or the
State of Florida (depending on the board or committee on wh ich I serve)_ 'July ,fgllwi ng the closing
of the calendar year on which I have served.
Ms. Jessica Fernanda Rechani
Sworn to and subscribed before me this Í q .J,'1 day NO V 2020
please visit the City of Miami Beach website at www .miamibeachfl.gov under City Clerk/Board and
Committees for additional information regarding the Financial Disclosure Requirements.
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibegchf,gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
(ton«
DIVERSITY STATISTICS REPORT
less.co
Last Name First Name
f
Middle Initial
The following information is voluntary and has no bearing on your consideration for appointment. It is being
asked to comply with City diversity reporting requirements.
Gender:
LOale > remale
O Other
O I prefer not to answer.
Race/Ethnic Categories:
What is your race?
O African American/Black
O Asian or Pacific Islander
O Caucasian/White
O Native American/American Indian
@ oner -Print Race: bani
0 I prefer not to answer. T
Do you consider yourself to be Spanish, Hispanic, or Latino/a?
Sfves
INo
O I prefer not to answer.
Do you consider yourself Physically Disabled?
@ ves
Í No
O I prefer not to answer this question.
Page 6 of 6
F:\C LE R\$A LL\RE G \B OA RD A ND CO M M ITT E E A PP LI C A TIO NS FIN A L D RA FT S\B OA RD A ND CO M M ITT E E A PP LI C A TIO N RE G FI NAL .docx
Updated: June 2020
MIAMl·DAD E-
EE, SOURCE OF INCOME STATEMENT
Section 2-11.1 (i) of the County Ethics Code requires that certain employees and public officials file a financial disclosure Statement on a yearly basis by July 1st
of every year.
Disclosure for Tax Year Ending ¡Last Name First Name Middle Name/Initial
2019 Rechani Jessica F
Mailing Address - Street Number, Street Name, or P.O. Box
3200 Collins Ave 111
City, State, Zip
Miami Beach, Florida, 33140
If your home address is your mailing address, and your home address is exempt from public records pursuant to Fla. Stat. §119.07, read
instructions on the following page and check here. O
Filing as an Employee (check one)
[] county 0 Public Health Trust [] Municipal:
(Municipality)
Department
Position or Title Employee ID Number
Work address I Work telephone Employment began on/ended on
Filing as a Board Member (check one)
[] county El Municipal: Miami Beach
(Municipality)
Board where serving
Disability Access Commitee
Alternate address (if home address is exempt) I Work telephone I Term began on/ended on
List below every source of income you received, along with the address and the principal activity of each source. Include your public salary. Place the sources of
income in descending order, with the largest source first. Examples of sources of income include: compensation for services, income from business, gains from
property dealings, interest, rents, dividends, pensions, IRA distributions, and social security payments. Also, include any source of income received by another
person for your benefit. However, the income of your spouse or any business partner need not be disclosed. If continued on a separate sheet, ch eck here.[]
I Name of Source of Income I Address I Description of the Principal Business Activity
N/A N/A Full Time Student
above is a true and correct statement.
12%202
Date signed
RECEIVED BY ELECTIONS DEPAR TMENT:
D Hardcopy RECEIVED
Y Electronic Copy
DEC 18 2020
CITY OF MIAMI BEACH
PIE rruçrTyCLERK
OFFICE USE ONLY Accepted: Y / N Deficiency: Processed Date/Initials: Scanned Date/Initials.
138_SP-14 COE 2016
MIAM I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
www._miamibeachfl.gov
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305.673.7411
BOARD & COMMITTEE FINANCIAL ACKNOWLEDGEMENT STATEMENT
Acknow ledgement of fines/suspension fo r Board/Com mittee Members for failure to comply with Miami-
Dade County Financial Disclosure Code Provision Code Section 2-11.1(i) (2)
ka.sa» Osca F
Last Name First Name Middle Initial
l understand that no later than July 1, of each_year all members of Boards and Committees of the City of Miami
Beach, including those of a purely advisory nature, are required to comply with Miami-Dade County Financial
Disclosure Requirements.
One of the following forms must be filed with the City Clerk of Miami Beach, 1700 Convention Center Drive,
Miami Beach, Florida, no later than 12:00 noon of July 1, of each year:
1. A "Source of Income Statement;" or
2. A "Statement of Financial Interests (Form 1)1;" or
3. A Copy of your latest Federal Income Tax Return.
e of these forms, pursuant to the Miami-Dade County Code, may subject the person to a fine
rjy$66$5600, 60 days in jail, or both.
1 1 /1 2 /2 020
Date
1 Members of the Planning Board and Board of Adjustment will be notified directly by the State of Florida,
pursuant to F.S. §112.3145(1)(a), to file a Statement of Financial Interests (Form 1) with the Miami-Dade County
Supervisor of Elections by 12:00 noon, July 1. Planning Board and Board of Adjustment members who file their
Form 1 with the County Supervisor of Elections automatically satisfy the County's financial disclosure
requirement as a Miami Beach City Board/Committee member and need not file an additional form with the Office
of the City Clerk. However, compliance with the County disclosure requirement does not satisfy the State
requirement.
Page 5 of 6
F:\C LE R\$A LL\RE G \BO A RD A ND COMMITTEE APPLICATIONS FINAL DRAFTS\BOARD AND COMMITTEE APPLICATION REG FINAL.docx
Updated: June 2020
\Es£4.±1 r #%22 Lal
1755 Meridian Avenue, Suite 200/Miami Beach, FL 33139/Ph: (305) 673-7505 or (305) 673-7000 ext. 6200 PARKING
A cityw ide (CW) parking permit is honored at metered parking spaces and restricted residential zones
parking spaces. A CW parking permit IS NOT honored in prohibited areas. An Access Card will be
provided to you for City Hall Garage (G7) access.
IMPORTANT NOTE: Your vehicle license plate serves as your "parking permit". In order to avoid
any unnecessary enforcement actions, it is important that our records reflect the most current and
accurate information regarding your vehicle license plate. Inaccurate and/or outdated vehicle
information may lead to the issuance of parking citation(s) and/or the towing of your vehicle.
Please note that this new access card CANNOT be hole-punched or perforated in any manner. To use
the new card please hold the card at close proximity to the reader until the gate opens. You may need
to try the other side of the card. Please ensure you hold the entire surface of the card against the reader
until the gate opens.
ACKNOWLEDGEMENT: I acknowledge that should my access card be lost, stolen or
damage, I will be responsible to pay a $10.00 replacement fee.
Board Member Information
Date of Application: Nvenor 13; 2020
Applicant Name: ,S3ca. R?echa;
Board/Committee Name: D;Sail+ AC€SS Co hb++€€
Address: 3a0 cons Ave 1,a; beach, ÉL, 33140
E-Mail Address: 5fr«chan;3ho1·Coh
wok me (5€)-37.- 1038 tor- mons (986)-3%-138
Cell Phone: (380-39-308 Preferred Contact Method: (]/hot,
Vehicle Information
Tag: RKH758 Color: Silver
State: Florida Year: 2019
Make: Subaru Model: Outback /")
Applicant Signature: RS ~
Please provide signed form to the Parking Department located at 1755 Meridian Avenue, 2" floor. Working
hours are 8:30 to 5:00 p.m. or email to: ParkingReception@miamibeachfl.gov
e-mail subject: BOARD & COMMITTEE PARKING APPLICATION - APPLICANT NAME
Parkina Department S
PERMIT SYSTEM GARAGE ACCESS
Expiration Date: ID Card Serial #:
Issued By Print Name: Print Name:
Signature: es Signature: es
Date Issued: Date Completed:
:\ping\$man\rar\forms \cw boards&committees parkingíorm.doc form updated 9/26/2017
M IA M I BEACH
City of Miami Beach
1700 Convention Center Drive
Miami Beach, Florida 33139
OFFICE OF THE CITY CLERK
Email: BC@miamibeachfl.gov
Telephone: 305 .673 .7 411
AFFIDAVIT OF AFFILIATION WITH THE CITY OF MIAMI BEACH
STATE OF FLOR[DA., ,„A
COUNTY OF pL iQ .- U d
I am in compliance with the affiliation requirement of Miami Beach City Code Sections 2-22 (4),
as (check (/) all that apply):
~ I am a resident of the City of Miami Beach for six months or longer.
D I have an ownership interest (for a minimum of six months) in a business established in the
City of Miami Beach (for a minimum of six months).
D I am a full-time employee of a business (for a minimum of six months) and I am based in an
office or other location of the business that is physically located in Miami Beach (for a
minimum of six months).
"Ownership Interest" means the ownership of ten percent (10%) or more (including the
ownership of 10% or more of the outstanding capital stock) in a business.
"Business" means any sole proprietorship, sponsorship, corporation, limited liability company,
or other entity or business association.
nakeg o5erjury, I declare that I have read the foregoing document and that the facts
1 /12403o
Signature
Seo Rethah;
Date
Printed Name
NOTARY
Sworn to (or affirmed) and subscribed before me, by means o~hysical presence or D online
neto.o a4? yewbe r _As DA 9e s#m ételas°
Jess, 'C ff l?ecivt N!J: (City of Miami Beach Board/Committee Member). K eoceeao [t )vere/ ¿eSe
Form of Identification
Peís onalb Kown
%/2.%5%3/%os-
Name of Notary, Typed, Printed, or Stamped
(NOTARY SEAL)
3M!A,, Charles J. DAgostin
00\l!;;, NOTARY PUBLIC
o] "- ê] „STATE OF FLORIDA
< ±l, Comm# GG168171
Pees ires 12/14/2021
,P g·
zier ' ' • 'R'S s · $" '45,2 •'pe'Gv"
a#%f7- za 1È,,osi"
''t?as"" '
..y ;y, i'' 'y ..0ii%{ 1,{$; ç %i
¡; „,s r'' é}..ss% te
A<
e
\
G»
~,
s·° ¢ -
,,
, <i,4,a%.
t
, ',i' Q',
9
,Y
à -»-
t
. • - ---- 2c-=--" ! . ';i
· I
'k A ;